Malawi Medical Journal 29 (2): June 2017 Noncommunicable Diseases Special Issue
Risk factors for chronic kidney disease 166
Original Research Risk factors for chronic kidney disease among patients at Olabisi Onabanjo University Teaching Hospital in Sagamu, Nigeria: A retrospective cohort study Temitope W. Ladi-Akinyemi1, Ikeoluwa Ajayi2 1. Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi Araba, Nigeria 2. Department of Epidemiology and Medical Statistics, University of Ibadan. Ibadan, Nigeria Correspondence: Dr Temitope W. Ladi-Akinyemi (
[email protected])
Abstract
Background Chronic kidney disease (CKD) is common and often goes undetected and undiagnosed until the disease is well advanced and kidney failure is imminent. It is estimated that approximately 36 million Nigerians suffer from different stages of CKD, as one in seven Nigerians has kidney disease. Methods This research was a retrospective cohort study of 150 cases and 300 controls. Selection of subjects was by a retrospective review of records of in-patients from 2010-2013 in a state teaching hospital. Data was analyzed using Chi-square at 5% level of significance. Results Majority of subjects were between ages 20 – 29 years. The mean (SD) age of the cases was 40.6 (14.4) and controls was 38.6 (15.8). Ninety (60%) of the cases and 212(70.7%) of the controls were males (p= 0.023). Almost 87% of the cases and 42% of the controls ingest herbal concoction. Use of bleaching substances was more among the cases 20(13.4%) compared with the controls 2(0.7%), ( p= 0.001). Eight (5.3%) of the cases had family history of CKD while only 1(0.3%) of the control had similar history (p= 0.001). There were more cases (10.7%) with diabetic mellitus compared with the controls (2.7%), (p= 0.001). The number of cases with high blood pressure was more than the number of controls, (p-value 120mmHg)
130 (86.7)
Mean SBP ± SD
Variable
159 (53.0) 141 (47.0)
179 (39.8) 271 (60.2)
Χ2 = 65.683
167.0 ± 40.0 130.3 ± 30.5
142.5 ± 38.0 t = 10.476
Normal (≤80mmHg)
38(25.3)
240(53.3)
Elevated (>80mmHg)
112(74.7)
98(32.7)
210(46.7)
Mean DBP ± SD 105±28.6
81±18.8
89.0±28.2
< 0.001*
< 0.001*
Diastolic (DBP) 202(67.3)
Χ2 =
70.875
t = 10.106
< 0.001*
< 0.001*
Hypertension Yes
91(60.7)
40(13.3)
131(29.1)
No
59(39.3)
260(97.3)
319(70.9)
Yes
16(10.7)
8(2.7)
24(5.3)
No
134(89.3)
292(97.3)
426(94.7)
Yes
10(6.7)
5(1.7)
15(3.3)
No
140(93.3)
295(98.3)
435(96.7)
108.721 < 0.001*
Χ2 = 12.696
0.001*
Χ2 = 7.759
0.005*
Χ2 = 8.779
0.006*
Χ2 = 15.842
< 0.001*
HIV
Urinary tract infection 6(4.0)
1(0.3)
7(1.6)
No
144(96.0)
299(99.7)
443(98.4)
Yes
11(7.3)
2(0.7)
13(2.9)
No
139(92.7)
298(99.3)
437(97.1)
Cancer
SD = standard deviation; * = statistically significant (P ≤ 0.05)
higher percentages of regular use of NSAIDS, chronic use of analgesic and addition of salt to cooked food prior consumption compared with the controls. The mean age of the cases was 40.6 (14.2) years while that of the controls was 38.6 (15.0) years and most of the cases and controls were less than 60years of age, a finding that is consistent with findings from similar study within and outside Nigeria where mean age of patient with CKD was 42 (15.43) years,13,14 but different from a similar studies from India where the mean age was 45.22 (15.2),15 Ogbomosho where the mean age of CKD patients was 50.52 (13.03) years and majority of the patients were ≥ 45 years,8 and another study from the USA where the mean age was 62 years.13 The findings from the study in the USA with highest mean age is as a result of high life expectancy and better quality of life due to the quality of health care and health policies as well as subsidized healthcare by the US government. The majority (28%) of CKD patient were within the age range of 30-39, followed by age range 20-29, then 40-49 and 50-59, while the majority (26.8%) of the controls were in the age range 20-29, followed by age range 30-39, then 40-49 and 50-59. This is consistent with study from Ilorin6 but different from study from Ogbomosho.8 Most of these patients are in their productive age, and this will definitely affect the economy of the country. Risk factors ascribed to chronic kidney disease in early ages are lifestyle for example consumption of alcohol, cigarette smoking, sociocultural practices such as the use of local herbs, disease states such as hypertension, diabetes mellitus, obesity, diet (high salt and protein intake, for example), sickle cell nephropathy, and infection. Most of the subjects (both the cases and controls) were males, a finding that is consistent with similar study in http://dx.doi.org/10.4314/mmj.v29i2.17
94 (62.7)
53 (11.0)
127 (28.2)
56 (37.3)
267 (89.0)
323 (71.8)
Χ2 = 132.083 < 0.001*
Chronic use of analgesics Yes
96 (64.0)
31 (10.3)
127 (28.2)
No
54 (36.0)
269 (89.7)
323 (71.8)
Χ2 = 192.177 < 0.001*
Addition of table salt to cooked food Yes
92 (61.3)
51 (17.0)
143 (31.8)
No
58 (38.7)
248 (83.0)
307 (68.2)
Χ2 = 90.820
< 0.001*
Χ2 = 3.153
0.076
Consumption of canned food Yes
3 (2.0)
1 (0.3)
No
147 (98.0)
299 (99.7)
4 (0.9) 446 (99.1)
NSAIDs = non-steroidal anti-inflammatory drugs; * = statistically significant (P ≤ 0.05)
Χ2 =
Diabetes mellitus
Yes
Yes No
Sagamu where more of the subjects were males,16 however the finding is different from similar study in Ogbomosho where most cases were females.8 The majority of the cases had secondary education, followed by those with no education. This can result in inadequate knowledge and awareness of CKD and its risk factors on the part of the cases regarding their lifestyle. This had been documented in another study.9 About half of the cases were unskilled, this is consistent with the result of a similar study in Ogbomosho where the majority of the cases were unskilled.8 Over 70% of the cases were married, this finding is consistent with similar study where most of the cases were married.8 Larger percentages of the cases ingest herbal concoction, this could be attributed to our sociocultural belief and lifestyles, and it could also be as a result of the state of the economy in the country. It is generally believed by the less educated and the unskilled population in Nigeria that it is more expensive to go to the hospital for treatment if you are sick compared with the use of herbal concoction, this is consistent with a similar study in Nigeria.8 In addition to these, more of the cases use bleaching substances compared with the control. This is because these people are ignorant of the content of this cream/soap and the damage they can do. Furthermore, world health organization (WHO) had revealed that 77% of Nigeria women, the highest in the world use skin lightening cream on regular basis. These bleaching substances contain mercury which damages the skin and the kidney of the user. More of the cases had a family history of CKD compare with the controls. Most of the cases had elevated systolic and diastolic blood pressure at presentation. More than half of these cases were not known hypertensive. The reason for this could be as a result of people’s attitude towards their health. Most Nigerians do not do routine medical checkup and by the time they are finding out that they have one chronic disease or the other, complications already set in. In most cases, it is the complication that brings them to the health facility. This could be attributed to lack of fund and ignorant on the part of the citizen and on the part of the government, it could be as a result of poor health planning and poor health facilities put in place. The mean (± SD) presenting systolic and diastolic blood pressure for the cases were 167.0 ± 40.0 mmHg and 105 ± 28.6 mmHg, respectively, a finding that is consistent with the result of a similar study from Sagamu, Ogun-State,16 and that of the controls were 130.3 ± 30.5 mmHg and 81 ± Malawi Med J. 2017 Jun;29(2):166–170
Malawi Medical Journal 29 (2): June 2017 Noncommunicable Diseases Special Issue
18.8 mmHg. More of the cases had high blood pressure and diabetes mellitus compared with the controls. Also, more of the cases compared with the controls were HIV positive. This is because HIV reduces body immunity and can lead to several organs damage. All these risk factors were statistically significant. These findings are consistent with the result of a similar study from the USA.13 More of the cases compared with the controls had history of urinary tract infection. Urinary tract infection (UTI) alone may not cause chronic kidney disease if well treated. But if the UTI is associated with other medical conditions such as, pregnancy, diabetic, sexually transmitted infection and urinary tract abnormalities, all this may cause scarring in the kidneys which can lead to chronic kidney diseases. More of the cases compared with the controls had cancers. CKD and cancer are connected in a number of ways, cancers can cause CKD either directly such as Paraneoplastic nephropathies or indirectly through the adverse effects of the therapies. Almost two-third of the cases compared to less than a third of the controls use NSAIDs. Likewise, more of the cases compared with the controls had history of chronic use of analgesics, this may be as a result of a lack of awareness of the side effects of these drugs on the part of the users. Another reason could be from self-medication and increase patronage of the patent medicine store instead of visiting the health facility for proper management. A finding consistent with the result of a similar study from USA.17 Majority of the cases and only a few of the controls adds table salt to already cooked food before consumption. These people might not be aware of the health implication of such practice. Study has shown that salt intake increases the amount of urinary protein which is a major risk factor for developing kidney disease and salt intake in CKD populations is generally high, and often above population average.18
Study limitations
Some of the case files were missing. Some important information was missing in some of the case files available. Some information was not properly documented. Some important information such as the weight, the height, and the body mass index were not available in the case file so risk factor such as obesity could not be analyzed. This study assessed lifestyle risk factors retrospectively, hence, the findings from these study is subject to recall bias.
Conclusions In this study, most CKD patients were males and females in their productive age, this may affect the economic growth of the country. The majority were unskilled and semi-skilled workers with secondary and no formal education. Hence, some of the risk factors of CKD were practiced by these people due to poor or lack of awareness of their health implications. Significant risk factors of CKD in this study were a family history of CKD, ingestion of herbal concoction, use of bleaching cream/ soaps, elevated diastolic blood pressure at presentation, history of high blood pressure, history of cancers and history of chronic use of analgesic. Based on these findings it was recommended that Government should increase the awareness of CKD, by organizing campaigns and increasing radio jingles on the causes and risk factors of CKD especially those that are lifestyle related as well as assist in the management of CKD when it is diagnosed. Furthermore, individuals should cultivate the habit of doing routine regular medical check and modify their lifestyle. http://dx.doi.org/10.4314/mmj.v29i2.17
Risk factors for chronic kidney disease 170
Competing interests All authors declare that they have no competing interests related to this work.
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Malawi Med J. 2017 Jun;29(2):166–170
